Vasa previa: A condition with diverse management approaches

Vasa previa is a life-threatening fetal condition in which unprotected fetal blood vessels traverse the membranes over or near the cervical os, placing the fetus at high risk of rapid exsanguination if the membranes rupture. Advances in prenatal diagnosis have markedly improved outcomes, but current standard management remains associated with notable perinatal morbidity due to preterm birth and risks associated with cesarean delivery for the mother. In the management of vasa previa, growing evidence supports outpatient monitoring and delayed delivery for carefully selected low-risk cases, aiming to balance fetal safety with maternal well-being and efficient use of healthcare resources. A major focus is the emerging role of fetoscopic laser photocoagulation (FLP), a minimally invasive procedure that ablates exposed fetal vessels in utero. FLP may allow for outpatient management. In selected cases of types II and III vasa previa, it could facilitate term delivery and vaginal birth. While preliminary results are encouraging, FLP remains investigational and should be confined to IRB-approved protocols at specialized centers. We emphasize the need for individualized care informed by anatomical subtype, clinical risk, and patient values. As clinical management moves away from uniform management toward more personalized strategies, future research must validate new approaches through prospective trials and long-term follow-up to optimize maternal and fetal outcomes.